家互操作性互操作性资源​​ ​

互操作性资源​​ ​

互操作性​​ ​

联邦互操作性指南​​ ​

互操作性和患者访问最终规则（CMS-9115-F）​​ ​

美国Medicare和Medicaid服务中心 (CMS) 发布了 2020 年 CMS 互操作性和患者访问最终规则，该规则要求Health Plan （如Medicaid ）与使用第三方应用程序的成员共享健康数据、 Provider Directory和处方集（涵盖）药品清单。​​ ​

访问 CMS.gov 了解更多关于互操作性和患者访问最终规则的信息。​​ ​

互操作性和事先授权最终规则 (CMS-0057-F)​​ ​

加州医疗保险付费服务优先授权指标报告​​ ​

美国Medicare和Medicaid服务中心 (CMS) 发布了 2024 年 CMS 互操作性和事先授权最终规则，该规则增加了更快、更数字化地获得批准（称为事先授权）的规则，旨在改善健康信息交换，为患者、医疗保健提供者和付款人提供适当和必要的健康记录访问权限。​​ ​

访问 CMS.gov 了解更多关于互操作性和事先授权最终规则的信息。​​ ​

为了遵守 CMS 互操作性和事先授权最终规则， Department of Health Care Services (DHCS) ) 需要每年在我们的网站上报告汇总的事先授权指标。 具体而言，这包括一份需要事先授权的物品和服务清单（不包括药品），以及上一个日历年（CY）中这些物品和服务的事先授权申请数据。​​ ​

公开报告事先授权指标，包括DHCS Program中的事先授权请求（治疗授权请求（ TAR ）和服务授权请求（SAR）），可以提高透明度和问责制，帮助患者了解事先授权流程，并使提供者能够评估付款方的绩效。​​ ​

查看事先授权指标： Medi-Cal Fee-for-Service事先授权指标报告。​​ ​

Provider Directory and Formulary API Public Endpoints​​ ​ 

As required by the CMS Interoperability and Patient Access (CMS-9115-F) final rule, the following public FHIR R4 endpoints are available for download in machine-readable JSON format. You need an app or system that reads JSON format to use the API endpoints as they cannot be viewed in a regular internet browser.​​ ​  

Provider Directory API​​ ​ 

The Provider Directory API endpoints include Medi-Cal in-network provider and pharmacy information in JSON format. Navigate to the Department of Health Care Services (DHCS) Developer Portal to access the URLs to access and automatically download the JSON files that together make up the Provider Directory API. DHCS Developer Portal Note: The use of pagination is strongly encouraged to prevent timeout by attempting to ingest the large file size of FHIR JSON data by the receiving system while using the Provider Directory APIs.​​ ​

Provider Directory API Descriptions​​ ​

  • Plan offerings and coverage information​​ ​
  • Provider identities​​ ​
  • Provider Roles​​ ​
  • Facility and organizational relationships​​ ​
  • Geographic and site-based information​​ ​
  • Services providers offer​​ ​

Formulary API​​ ​ 

The Formulary API endpoint includes Medi-Cal covered drug information in JSON format. Navigate to the Department of Health Care Services (DHCS) Developer Portal to access and automatically download the JSON files that together make up the Formulary API. DHCS Developer Portal Note: The use of pagination is strongly encouraged to prevent timeout by attempting to ingest the large file size of FHIR JSON data by the receiving system while using the Formulary APIs.​​ ​

Formulary API Descriptions​​ ​

  • Full list of all formulary drugs​​ ​
  • List of formulary drugs by the drug tier of brand or generic​​ ​
  • Search the Formulary drugs by a specific drug name​​ ​
  • Search the Formulary drugs by a specific drug code​​ ​
  • All drug codes in Medi-Cal fee-for-service formulary​​ ​
  • Full list of all Medi-Cal fee-for-service formulary with pagination​​ ​